Up and down, up and down. Just when I think I have pump rates set so that "in range" is a reasonable goal for the immediate future, diabetes goes and changes everything again. Call it Murphy's Law, call it karma, call it whatever you want, I call it living with diabetes. At it's best, it's manageable; at it's worst, it's a roller coaster, but it's always uncontrollable. And the more we try to control it, the more elusive that control becomes.
After some pretty decent bg readings for most of September, we have seen some consistent highs for the first half of October. And not "high" highs, which are so much easier to correct, in my opinion, with a nice, big, well-measured bolus. No, we've been dealing with what we call "low" highs in our house - those pesky high blood sugar levels that don't appear to be have an obvious cause. The ones that hover just a little above the "ideal" range; too low to continually correct, to high to ignore. The 11's were our battle for Thanksgiving. Not just one, not two, not even three, but a solid 48 hours of blood glucose readings ranging from 11.0 mmol/l (198 mg/dl) to 11.5 mmol/l (207 mg/dl). Furthermore, Dylan felt fine. He didn't feel high and wasn't showing any symptoms of hyperglycemia. It didn't seem to matter what he ate, or how many times we corrected the highs, the next reading was another 11. We changed infusion sets, tried a new vial of insulin, double checked against multiple meters and the result was still the same...11s. It became a bit of joke with Dyl after a while, as he'd test and then say to himself, while waiting for the number to appear on the meter screen, "anything but 11."
What does one do in that situation? Personally, I am always hesitant to adjust basal rates because so many things can cause a temporary increase in blood glucose levels. Maybe Dylan was under a bit of stress, or fighting the early stages of a virus. Perhaps he had a decreased amount of exercise for that 48 hour period. Or maybe it's the beginning of puberty - something I've been dreading, from a diabetes standpoint, for a while now. The point is, it's so hard to determine what causes a rise in bg, that basal adjustments are not always the best answer.
So I did what I usually do in this situation, after I've tried the obvious solutions (bolus, increased water, bout of exercise, infusion set change, new insulin, different meter) and haven't seen success - I look to the numbers to tell me. After all, numbers don't lie. And while a single number, or even a day's worth of data, can't always provide a clear picture, trends over time can reveal a lot. So I sat down at the computer, uploaded the last two weeks of pump data, and stared long and hard at the information, looking for trends, patterns, or anything that would shed light on the situation. Sure enough, I quickly discovered a number of problems. Twice during the day, for the past 2 weeks, Dylan's bg levels had been quite elevated (prior to the 2 days of 11's). It was always at the same time each day, and always a similar level of elevation. So I increased the basal rates for the few hours prior to those 2 times, in the hopes that it would help to curb the spike.
I then texted the endocrinologist to let her know that I had uploaded new data, and increased two of Dylan's six basal rates. I also asked if could she please let me know if any other changes were required. Yup, after almost 7 years of parenting a child with diabetes, I still ask the endo about every change to pump settings. And I probably always will.